Quiz 5

Auditory Training

• Speech recognition can remain a problem even with appropriate amplification

  • communication breakdowns still occur

  • most individuals are not completely satisfied with amplification only

Auditory Training Aims to?

• develop/ improve speech recognition

• maximize residual hearing

• improve satisfaction with amplification

Learning to Listen in Auditory Training

• Use auditory signal to accurately interpret experience

• sound object and speech sound association

• music perception

Hearing and Listening are the same? T/F

• FALSE

Hearing

• ability to detect sound

• acoustic energy to electrical energy through auditory system (ear spaces)

Listening

• ability to interpret sound and give it meaning and value

Auditory Training has similar goals and objectives as?

• Speech and lip reading training

• similar progression of skills/ content with stimuli

• Auditory input only

  • use of residual hearing

Auditory Training goals take away?

• visual input to regrow auditory pathways

• ex: clinician covers face for speech perception to avoid client relying on lip reading

Listening to speech with Hearing Loss

• hearing loss can act as a filter, altering or eliminating sounds that are not of relatively high amplitude

• Background noise can exacerbate the issue, further reducing the audibility of speech sounds

Sensorineural Hearing Loss can:

• Impair speech recognition

  • Distortion: causes sound transmission to break down in the inner ear, cochlea or within brain (auditory nerve)

Conductive Hearing Loss can:

• Impair speech recognition

  • Amplitude: sound transmission breaks down in the outer or middle ear

Mixed Hearing Loss can:

• can impair speech recognition

• distortion and amplitude

• repetition helps build these pathways

Sensorineural Hearing Loss

• frequency selectivity

• Temporal resolution: issues with timing of speech

• Poor frequency selectivity can cause speech sound to sound alike

  • key vs coup

  • Key vs Me

• Poor temporal resolution can make it difficult to know when one speech sound ends and when another begins

• Perceptual Effort: fewer cognitive resources

• Working memory

• Long term working memory

An individual with sensorineural hearing loss may experience?

• poor frequency selectivity: speech sounds, sound alike

• poor temporal resolution: not knowing when one speech sound ends/begins

• Inability to participate in a conversation or recall what was said in a conversation or answer questions about the topic

__ is key in Auditory Training

• Amplification

• must be appropriate fit

• enhances potential benefit from training

• Frees up perceptual effort

Hearing aid and Cochlear Implant Check

• to make sure the patient can hear properly

• wand checks cochlear implants and that he magnet is in place and properly connected

Auditory Training Candidacy

• Children with pre-lingual hearing loss

• Children with post-lingual hearing loss

• Adults

  • Receive training less commonly than children but still need it

    • just received cochlear implants or hearing aids

    • sudden hearing loss

    • recent change in hearing

Training Programs: Phoneme Based

• typically includes nonsense syllables

• C-V-C structure

• V-C-V structure

• words in static context

• Learning to discriminate smaller speech segments leads to discriminating larger speech units

Training Programs: Word based

• includes words

  • open or closed sets

Training Programs: Analytic

• smaller sets of speech sounds

Training Programs: Sentence Based

• includes sentences

• open and closed sets

Training Programs: Cognitive Based

• Working memory, processing speed, attention

Training Programs: Music Perception/Synthetic

• Timbre, melody, pitch, rhythm, songs

Auditory Training: Four Design Principles

• Auditory skill

• Stimuli

• Activity type

• Difficulty level

Four Design Principles: Auditory Skill (Easy to difficult)

• Sound detection or awareness

  • auditory localization

  • auditory attention/selective attention: block extra noise and focus on speech sounds

• Sound discrimination: comparison of two sounds

• Identification: demonstrate a certain level of recognition “show me green” identify items or speech sounds in a set

• Comprehension :most difficult task patient demonstrates some level of understanding involves memory, cognition and processing

Writing SMART goals for the client:

• pros: sounds that are functional in their environment, progress faster

• cons: no direct observations as a clinician, accuracy issue

Four Design Principles: Stimulus Units

• The stimulus used in training activities

  • Analytic and synthetic activities

• Analytic: segments if speech

  • phonemes, nonsense syllables, cvc

• Synthetic: recognizing the meaning of an utterance

Four Design Principles: Activity Kind

• The nature of the activity

• Formal activities

  • occur during set times or session

  • one-on-one or in group

  • highly structured

  • may involve drills

  • receive reinforcements

• Informal activities

  • occurs during daily activities

  • ex: teacher alerts child to class bell

• Optimal training involves formal and informal activities

Four Design Principles: Difficulty Level

• The level of difficulty inherent in training activity

• Closed word stimulus → Open set stimulus

• Words stimulus unit → Complete sentences

• Dissimilar stimulus similarity → similar stimulus

• high context → low context

• structured task → spontaneous task

• Good S-N-R → Poor S-N-R

More different stimuli or different contrast the easier it is for client?

• TRUE

Cycling

• a patient doesn’t have to meet one training objective before moving to the next one

• Presenting a skill within a time period then moving to another objective then returning to the original objective later

• working on something more difficult can provide clarity on the easier things

Length of Time

• Just depends!

• depends on the time you’re going to spend with that client overall

• depends on what else you want to work on with the client (communication strategies, lip reading etc.)

Hierarchy

1. Comprehension: hardest

2. Identification

3. Sound Discrimination

4. Sound Detection & localization: easiest

Vowel Analytic Training Objectives

• at start of training, a hierarchy of objectives is developed

  • what are client’s current skill levels?

  • which sequence might best develop advanced listening skills?

• Limited Auditory skills

  • begin with awareness of sound

  • then move to gross discrimination (loudness, pitch, rate)

Begin Analytic Training Activities

• 1st begin with vowel awareness and identification

  • more intense than consonants

  • more low frequency energy

  • more readily perceived

• 2nd Consonant recognition

  • consonants are harder to hear than vowel sounds because vowels are more acoustically salient and louder than consonants

__ and __ provide the easiest access to speech sounds?

• louder; low

Training Objectives are designed to?

• Contrast vowels that have different formants

• ex: key vs coup

• heed vs had

Vowel Training: First and Second Formants

• Combination of F1 & F2 cause each vowel to sound different

• First Formant: Determined by how wide you open your mouth

  • If you vocalize with your mouth relatively wide open

    • High frequency 1st formant like /a/ in “sod”

  • If you vocalize with your mouth more closed

    • low frequency 1st formant like /u/ in “blue”

Formant 1

• Higher open more mouth = higher frequency

• closed mouth = low frequency

Formant 2

• More forward tongue = higher frequency

• more back tongue = lower frequency

2nd Formant in Vowel Analytic Training

• Influenced by tongue position

• if tongue is more forward

  • high frequency 2nd formant like /i./ in “seed”

• If your tongue is back toward the throat

  • lower frequency 2nd formant like /u/ in “you”

Once a patient has demonstrated vowel awareness?

• Then objectives may be discrimination then identification

• Difficulty hierarchy for objectives

  • Easiest: vowels that differ in 1st formant information

  • ex: shoe/shop, bee/bat

  • vowels that differ in 2nd formant information

  • ex: bee/boo, book, bit

  • Hardest: vowels with similar 1st and 2nd formant information

  • ex: pen/pain, ship/ sheep